Are all three ankle bones broken? Let's talk about this Trimalleolar Fracture!

Imagine that you suddenly rolled your ankle while going down a flight of stairs, playing sports, or walking on the road. With that, you felt unbearable pain and could not even put your foot down. The most serious thing that could happen at a time like this is a broken ankle. However, `Trimalleolar Fracture` is a bit more complicated and requires more attention. So today, let's talk about this simply, in a way that you can understand.

Simply put, what is this Trimalleolar Fracture?

This name may sound a bit complicated, but the meaning is quite simple. Trimalleolar means 'three'. This means that all three of the main bones that make up your ankle joint break at the same time.

Our ankles are formed by the joining of the ends of two bones in the lower leg. Let's take a look at what they are.

• Tibia: This is the large, strong bone in your lower leg. At its lower end, it has two parts that form the ankle joint.
• Medial Malleolus: This is the bony bump that you can feel on the inside of your ankle.
• Posterior Malleolus: This is the part that is located at the back of the ankle bone.

• Fibula: This is the thin bone that runs parallel to the fibula, on the lateral side.
• Lateral Malleolus: This is the bony bump on the outside of your ankle that you can grip with your hand.

So, in a `Trimalleolar Fracture`, all three of these parts - the medial malleolus, the lateral malleolus, and the posterior malleolus - are broken. It's like a frame that supports the leg breaking on all three sides at once.

Is this a serious injury?

Yes, this is actually a more serious and complex injury than a simple ankle sprain. But don't worry, if treated properly, it can be completely cured. There are several reasons why this can be serious:

• Surgery may be necessary: ​​Often, surgery is required to repair this type of fracture.
• Healing time: Because all three bones need to heal, you may not be able to put your foot down for several months. This means it will be difficult to perform daily tasks, go to work, and drive.
• Damage to surrounding tissues: When a bone breaks, the surrounding ligaments and tendons can also be damaged, which can further prolong the healing time.
• Risk of developing arthritis: There is a high chance of developing arthritis in that ankle joint in the future.
• Limping: Even after complete recovery, some people may have a slight limp when walking for a while.

What causes this kind of breakup?

There are several main reasons for this situation. Let's take a look at what they are.

What is the difference between Trimalleolar and Bimalleolar fractures?

You may have also heard of a `Bimalleolar Fracture`. The difference between the two is simple.

• Bimalleolar Fracture: In this, only the two bones on either side of the ankle (the `medial` and `lateral malleolus`) are broken.
• Trimalleolar Fracture: In this case, in addition to the two joints, the back part of the ankle bone (the `posterior malleolus`) is also broken. This means that there are three fractures.

What are the symptoms?

When a breakup like this happens, you start to feel these symptoms immediately.

• Sudden unbearable pain.
• Inability to put the foot down or walk on that leg.
• Swelling in the ankle area (maybe severe swelling).
• Bruised, blue appearance around the ankle.
• Sometimes you can see the deformation to the point where pieces of bone are visible.

How does the doctor treat this?

When you go to the hospital, the doctor will first give you pain medication. Then, he or she will take an X-ray to confirm the fracture and see how serious it is. You may also need a CT scan or MRI scan to get a clearer picture.

Treatment for this type of fracture often requires surgery. This procedure is called Open Reduction Internal Fixation (ORIF).

What is ORIF surgery?

This means:

1. Open Reduction: The surgeon cuts the skin, exposes the broken bone fragments, and rearranges them in their correct positions.

2. Internal Fixation: The bone fragments are fixed internally using metal plates, screws, or wires to prevent them from moving again.

After this surgery, you will need to wear a cast or a special brace on your leg until the bone heals.

Recovery time and things to be aware of

This is the hardest time for many people, because it requires both patience and time.

When will I be able to walk after the surgery?

Usually, your doctor will not allow you to put weight on your injured leg or put it on the ground for at least 6 weeks after surgery. This is necessary for the bones to heal. After that, you can gradually start walking with weight on your leg with the help of a physiotherapist.

Will I be able to go back to work?

This varies depending on the job you do.

• You should always keep your leg elevated, at least for the first two weeks after surgery.
• It may be difficult to walk for about 6 weeks, so going to and from the office may be a problem.
• Because you're taking painkillers, it can sometimes be difficult to concentrate on work.

Therefore, it is best to talk to your doctor and start working out at a time that suits you.

When will you be able to drive?

This can take several months . You cannot drive while the cast is in place. Even after it is removed, you will have to wait until you regain strength and control of your ankle. If you drive too quickly, you are more likely to have another accident.

When you need to see a doctor urgently

During your recovery, if you develop any of the following symptoms, notify your doctor immediately or go to the Emergency Department (ETU) of the nearest hospital.

• If you feel feverish or have a cold.
• If a pus-like fluid is draining from the surgical wound.
• If the area around the wound is red, swollen, and too painful to touch.
• If you think you've fallen again and hurt your leg.

These can be signs of an infection, so it is very important to seek treatment quickly.